What It Was Like To Be Sick In 1884

American medicine in a crucial era was at once surprisingly similar and shockingly different from what we know today. You could get aspirin at the drugstore, and anesthesia during surgery. But you could also buy opium over the counter, and the surgery would be more likely to be performed in your kitchen than in a hospital.

Nevertheless, these ideas were in the process of rapid change at precisely this moment. The previous year the German bacteriologist Robert Koch had announced his discovery of the organism responsible for cholera and the year before that, in 1882, of the tuberculosis bacillus. Thus, within the space of two years, one scientist had unearthed the cause of the century’s greatest killer and its most feared epidemic disease. (Cholera killed far fewer than tuberculosis, but its abrupt and unpredictable nature made it particularly terrifying. ) Both discoveries had made front-page news, but it was not yet clear what they meant in practical terms. Like many physicians, most wellinformed laymen were still a trifle skeptical. “Now the microbe may be a very decent fellow, after all, when we get acquainted with him,” as one whimsical observer put it, “but at present I only know him by reputation, and that reputation has been sicklied o’er with the pale cast of thought of medical men … who have charged him with things that we, unprofessionals, look to them to prove. ” Not only did many Americans share such sentiments, but the technical means to turn this new knowledge into public health practice and effective therapeutics still lay in the future.

Bacteriological techniques, for example, had not yet become so routine that suspected cases of typhoid or tuberculosis could be diagnosed—and thus made the basis for a program of isolating sufferers. Public health departments, in any case, were unaccustomed to exercising such power or supporting laboratory work. And there were other problems as well. Physicians were still unaware that certain ills might be spread by individuals displaying no apparent symptoms—so-called healthy carriers—or by insects. (Though careful readers of the medical journals in 1884 might have taken notice of the report from a Cuban publication that a Dr. Juan Carlos Finlay had suggested that yellow fever might be spread by mosquitoes—a conjecture proven correct by a team of American investigators at the end of the century.) Perhaps most frustrating to doctors sympathetic to the germ theory was the difficulty of turning this insight into usable therapeutic tools. Knowing what caused a disease, after all, was not the same thing as treating it.

WE CAN HARDLY EXPECT age-old medical ideas to have changed overnight—especially in the absence of new ways of treating patients. Physicians still found it difficult to think of diseases as concrete and specific entities. Fevers, for example, still tended to melt into each other in the perceptions of many doctors; diphtheria and croup, even syphilis and gonorrhea, were regularly confused. It was not simply that such ills were hard to distinguish clinically but that many physicians believed that they could shift subtly from one form to another. Perhaps most interesting from a twentieth-century perspective, physicians still were very much committed to the idea that environmental factors could bring about disease. Every aspect of one’s living conditions could help create resistance or susceptibility to disease; and some factors, such as poor ventilation or escaping sewer gas, seemed particularly dangerous. Stress or anxiety also could produce any number of physical ills. Thus, a leading medical school teacher could explain to his class in 1884 that diabetes often originated in the mind.

Medicine always had found a place for stress and the “passions” in causing disease, and by the early 188Os physicians had begun to show an increasing interest in what we would call the neuroses: complaints whose chief symptoms manifested themselves almost entirely in altered behavior and emotions. Such ills were becoming a legitimate—in fact, fashionable—subject for clinical study. Depression, chronic anxiety, sexual impotence or deviation, hysteria, morbid fears, recurring headaches all seemed to be increasing. One particularly energetic neurologist from New York, George M. Beard, had just coined the term neurasthenia to describe a condition growing out of environmental stress and manifesting itself in an assortment of fears, anxieties, and psychosomatic symptoms. Beard himself believed that America was peculiarly the home of such ills because of the constant choice and uncertainty associated with the country’s relentless growth.

This interest in emotional ills is not important only in and of itself; it is also evidence of the significance of a new kind of specialist, the neurologist. Even if such bigcity practitioners represented only a small minority of the total body of physicians, and even if they treated a similarly insignificant number of patients, these specialists were forerunners of a new and increasingly important style of medical practice. By 1884 urban medicine was in fact already dominated by specialists—by ophthalmologists, orthopedic surgeons, dermatologists, otologists and laryngologists, obstetricians and gynecologists, even a handful of pediatricians—as well as the neurologists. Many such practitioners were not exclusive specialists; they saw patients in general practice, but their reputations—as well as the bulk of their consulting and hospital practice—were based on their specialized competence. They were the teachers of a new generation of medical students, and it was their articles that filled the most prestigious medical journals.